How does virtual reality compare to preparation books and Child Life programming for reducing anxiety and motion during medical imaging? A randomized clinical trial (Preprint)

BACKGROUND Magnetic Resonance (MR) Imaging is anxiety-provoking, particularly for pediatric patients and their families. Anxiety and non-compliance (ie, movement during imaging) are often managed with sedation; however, the psychological, physiological, and health systems impacts related to sedation have necessitated alternative methods to improve success with non-sedated MR imaging. OBJECTIVE To compare the effectiveness of virtual reality to a preparatory book and Child Life program for reducing motion and anxiety during pediatric MR imaging. METHODS A non-blinded, randomized clinical trial with three arms, including virtual reality (VR), the hospital’s preparation book (BLK), and the hospital’s Child Life Program (CLP), was conducted among children aged 4-to-13 years. Participants progressed through preparing for a head scan with their allocated preparation program, then completing the head scan in the hospital’s MRI simulator room. The primary outcomes were a success during the MR simulator and situational anxiety. Data were collected via REDCap at baseline, after preparing, and after the simulated scan. We secondarily administered measures of caregiver anxiety, usability, and satisfaction with the preparation programs. RESULTS A total of 84 participants were recruited and enrolled in the study (VR n=30, BLK n=24, CLP n=30). No significant differences were found between the groups on success in the MR simulation assessment (X2 = 2.642, p = 0.267, df = 2). Children preparing with the book exhibited trends of higher anxiety between preparation and the assessment than children preparing with VR (x ̅ =1.12, 95% CI = 0.01 to 2.25, p = 0.053). The caregivers in the BLK arm also reported being significantly more anxious than the caregivers in the VR group before the assessment (x ̅ = 5.33, 95% CI = 3.24 to 7.43, p < 0.001) and CLP group (x ̅ = 3.73, 95% CI = 1.64 to 5.83, p < 0.001). Caregiver anxiety in the BLK group continued after the assessment was over and remained higher than the VR group (x ̅ =1.84, 95% CI = 0.25 to 3.43, p = 0.019). In terms of satisfaction with the preparatory materials, children reported more satisfaction in the CLP group compared to the BLK group (x ̅ = 17.51, 95% CI = 0.07 to 34.95, p = 0.049), whereas, caregivers preparing with VR or CLP reported the most satisfaction (x ̅ = 4.51, 95% CI = 2.32 to 6.70, p < 0.001; x ̅ = 4.07, 95% CI = 1.86 to 6.28, p < 0.001, respectively). In all groups, the children reported feeling that the actual experiences with the preparation materials matched their expectations [F(2,81) = 1.014, p = 0.367]. CONCLUSIONS Virtual reality preparation could be a viable alternative to sedation when utilized to improve process compliance and effectiveness of pediatric medical imaging. Future research should focus on testing with pediatric patients in clinical care settings. CLINICALTRIAL U.S. National Library of Medicine (#NCT03931382)